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Background/Aims@#Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. @*Methods@#Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. @*Results@#Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. @*Conclusions@#FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment.
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Objective:To identify factors that discriminate between transient and permanentcongenital hypothyroidism. Methods: Retrospective evaluation of 58 children withcongenital hypothyroidism and eutopic thyroid gland. Gender, gestational age, birth weight,TSH and serum thyroxine levels at diagnosis and L-thyroxine dose at 12 and 24 months ofage were analyzed. Results: Median (IQR) initial TSH levels were 73.3 (276.5) ?IU/mL inpermanent hypothyroidism and 24.24 (52.7) ?U/mL in transient hypothyroidism (P =0.0132).The optimum cut-off value of initial TSH to predict transient hypothyroidism was 90 ?IU/mL.Mean (SD) L-thyroxine doses at 24 months of age were 2.64 (0.98) ?g/kg/day in permanenthypothyroidism and 1.91 (0.65) ?g/kg/day in transient hypothyroidism. Requirement of L-thyroxine dose at 24 months of ?0.94 ?g/kg/day had the highest sensitivity (100%) to predicttransient hypothyroidism. Conclusions:L-thyroxine doses at 24 months can predicttransient hypothyroidism in patients with eutopic thyroid gland earlier than at 36 months.